Fusion of both coronal sutures leads to a head shape called “bracycephaly.” This causes restriction of growth of the anterior fossa resulting in a shorter and wider than normal skull. Compensatory vertical growth also occurs, which is called turricephaly. Bicoronal synostosis is often seen in patients with associated syndromes such as Crouzon, Apert, Saethre-Chotzen, Muenke and Pfeiffer syndromes. These patients can also have additional sutures that are prematurely closed.
Surgical therapy consists of fronto-orbital advancement and cranial vault reconstruction aimed at enlarging the anterior portion of the skull. Patients with an underlying syndrome are more likely to have multi-suture synostosis and other facial abnormalities. Surgical therapy is often specific to each patient. For the coronal sutures, surgical repair with a fronto-orbital advancement is optimal between 9 and 12 months of age. If posterior sutures are also involved, then a staged approach is typically undertaken with a posterior vault remodeling at 3-6 months followed by a fronto-orbital advancement at 9-12 months.